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August 2002

Herb Safety Questioned
Hormone Replacement Therapy
HRT Risks
Alternatives to HRT
Ask Dr. J: Blood Pressure/Lipids
In the Health News
Diet and Disease
Recipe of the Month: A Light Summer Fruit Salad

Herb Safety Questioned

Dear Friends,
A recent news headline suggested that herbs are toxic, and that if you are smart, you will probably avoid them. In reading through the rest of the article you find out that two patients took a combination of Chinese herbs, used by Chinese physicians for specific therapy, and they developed serious liver disease. (The authors scoured the medical reports to find 29 other patients who had some side effects from these herbs.)

These are not the common therapeutic herbs increasingly used in western medicine, but potent Chinese prescription medications used for more serious diseases (perhaps inappropriately in these cases for minor problems). They might have some significant side effects, but it is only by inappropriate extrapolation that you could consider the common herbs taken every day by millions of people to be significant risks to health.

The authors argue that the lack of regulation of herbs leads to serious risks. But this is clearly not the case. The prescription drug market is highly regulated in the United States. These medications have uses that often save lives and relieve suffering when used appropriately. Nevertheless, even when used correctly, side effects of prescription drugs in the United States are serious, frequent, and potentially lethal.

These statistics do not even account for the situations when they are improperly prescribed or administered, or when they are abused. Drugs that are recommended every day by physicians, kill far more people than car accidents. In fact, over 100,000 deaths are attributed to correctly used drugs. When it comes to dangerous side effects, they are in a completely different league than herbs, vitamins, minerals, essential fatty acids, and other dietary supplements, even those with the highest risk profile. Regulation is apparently not a cure for the dangers of serious herbal side effects, since it has not eliminated risks from prescription medications.

I think the real objection of most doctors would be that these risks are unnecessary, because they do not believe in the therapeutic value of herbs. This is another issue that was not discussed in the article. It makes me wonder how many people have been helped by their use of these herbs, and how many people were able to avoid drugs through their use of unregulated Chinese medicines.

The most common herbs in use in western cultures, such as saw palmetto, ginkgo, nettle, milk thistle, ginseng, ginger, St. John’s wort, and garlic, among others, are extremely safe, have only rare minor side effects, and are often very effective in treating the conditions for which they are recommended. I use these herbs all the time in my medical practice, and have only rarely encountered side effects, and am often able to reduce or eliminate the need for more risky prescription drugs.

Hormone Replacement Therapy
The Journal of the American Medical Association (JAMA) recently published an article on hormone replacement therapy (HRT) in menopausal women reporting data from the Women’s Health Initiative (WHI).

The report was widely carried in the press because it concluded that a long-term study of HRT should be stopped early because of the increased risks of invasive breast cancer and heart disease. Since then I have been extensively questioned by patients, friends, and relatives about the issue, asking if they should continue their HRT.

When I recommend hormones, I always suggest those that are identical to the ones produced in the body. This study examined the effects of two commonly prescribed hormones that I have never recommended. Premarin, estrogens derived from horses, and methylhydroxy progesterone (Provera), a synthetic analog of progesterone, not progesterone itself.

These hormones are not identical to human hormones, and they have different effects. The supposed benefits of Premarin and Provera have been questioned earlier, and this study is just a confirmation of other work. For example, in the Heart and Estrogen/progestin Replacement Study (HERS), heart disease risk was not lowered, although estrogen can improve lipid levels.

HRT Risks
Estrogens can dilate coronary arteries, but the addition of Provera negates that beneficial effect on circulation. A 1999 study showed that Provera also leads to progression of coronary disease, increases lipid uptake in plaque, causes abnormal sugar regulation, and increases the likelihood of blood clots in blood vessels. It is not surprising that an increased risk of heart disease was shown in the latest study.

A study in 1997 showed that estrogens increased the risk of breast cancer, and that administering synthetic progesterone-like hormones added to the risk. In the Journal of The National Cancer Institute, regarding combined hormone therapy, the authors concluded: “This study provides strong evidence that the addition of a progestin to HRT enhances markedly the risk of breast cancer relative to estrogen use alone.”

It is easy to see why conventional HRT is increasingly questioned. However, the evidence suggests that using natural hormones, identical to those produced in the body, does not pose the same risks, and indeed may reverse them. In addition, they may help preserve youthful skin, brain function, heart health, and bone density, while controlling hot flashes and other menopausal symptoms.

Alternatives to HRT
Women seeking alternatives to any hormone replacement therapies have many options, including for menopausal symptoms such as hot flashes, vaginal dryness, depression, anxiety and loss of libido. Plant chemicals similar to estrogens in soyfoods and flaxseeds may help relieve hot flashes and vaginal dryness.

Supplements of bioflavonoids (2000 mg daily) and vitamin E (800 IU) often control hot flashes, although adding black cohosh (standardized extract, 80 to 120 mg) can also help. The emotional symptoms may be relieved with St. John’s wort(900 mg of standardized extract) or calming herbs, such as valerian. Exercise is one of the best treatments for anxiety and depression, and it often relieves hot flashes.

For reducing heart disease, a whole foods diet, regular exercise, and supplements of vitamins C and E, B6, folate, and B12, as well as magnesium, coenzyme Q10, garlic, and octacosanol, among others are very helpful.

For reducing osteoporosis, and even building bone, a number of lifestyle changes are valuable. Weight-bearing exercise and a diet that contains soyfoods, such as tofu, and is low in animal proteins, sugar and other refined carbohydrates, and caffeine, are all important. It is essential to get adequate calcium and vitamin D, and it may help to take supplements of ipriflavone (600 mg), a compound related to the isoflavones found in soy, and the mineral boron (3 mg).

For cancer prevention, follow these same lifestyle changes. Be sure to exercise regularly, maintain a healthy weight, eat a diet high in protective compounds found in vegetables, fruits and berries, whole grains and beans, and protect your defenses, including your immune system, by controlling stress and taking a variety of dietary supplements (antioxidants, selenium, flavonoids, and immune supports such as proanthocyanidins from grape seeds, several mushroom extracts, and a variety of herbs).

To maintain brain function after menopause, persisting in regular exercise, both physical and mental, is essential. It also helps to maintain cultural activities, such as reading, playing music, and going to theater, and maintaining rewarding social interactions. Supplements of ginkgo biloba, vitamin E, N-acetyl cysteine, and acetyl L-carnitine all appear to help, as well as melatonin and alpha-lipoic acid, which are excellent brain antioxidants.

Hormone therapy may still be valuable, as long as you choose natural hormones that are bio-identical to those produced in your body. This means natural progesterone, not synthetic analogs, and estrogens that are identical to human hormones–mainly estriol, with small amounts of estradiol and estrone (this is commonly referred to as “tri-est” by compounding pharmacies). These are much safer than the hormones reported in the JAMA study, and do not have the same side effects. Your doctor can prescribe specific levels for you, depending on your medical history and appropriate testing.

Ask Dr. J
Q. I have been battling high blood pressure andcholesterol for six months with great success, but my pressure is still 140/80 and my cholesterol is 255. Do you have any supplement suggestions? GF, Maryland, via Internet

A. Sounds like you have been doing many of the right things with diet and exercise, but you might need more than three days of exercise a week, and some stress management. While you say your diet is good, and you have lost 30 pounds, you still have a bit more to lose, but you should focus on health as the goal of your diet, rather than weight.

My guidelines for diet are mainly vegetarian, whole foods, with small amounts of fish, non-fat, organic yogurt, and organic eggs. Avoid sugar, white flour, and especially hydrogenated oils, such as margarines and shortening. Including freshly ground flaxseeds and other seeds and nuts will give you some of the vital essential fatty acids. Focus on vegetables, fruits,whole grains, and beans, including natural soy products.

For supplements, many might help. I recommend a higher potency multi than the one you are taking (Ultra Vitality from QCI Nutritionals is a good one). Your chromium is fine at 600 mcg, as it helps to regulate blood sugar and lipids. Vitamins C (3 to 4 gms) and E (400 to 800 IU) can lower blood pressure, as can fish oil (4 to 8 gms).

Magnesium (500 to 1000 mg) also helps with blood pressure, as it relaxes the blood vessels. Coenzyme Q10 is not only an excellent antioxidant, it also lowers blood pressure while supporting the heart, reducing heart failure, unlike some medications which lower blood pressure by suppressing heart function.

For cholesterol, try a supplement called octacosanol (10 to 20 mg), which is better and safer than statin drugs. It is also known as policosanol (see the article in the April issue on my website). Any of the following might also be helpful: deodorized garlic (1000 to 2000 mg), inositol hexaniacinate (1600 mg), pantethine (1000 mg), or red yeast rice extract (1000 mg).

In the Health News
Breast cancer may have some genetic component, but it is unlikely to be the most serious contributor to the disease. Breast cancer in Asian-American women in the Los Angeles area has increased dramatically, and it is contrary to the rates seen in their countries of origin (Deapen D, et al., Int J Cancer (2002 Jun 10) 99(5):747-50.) In the past, Asian-American women have had very low rates of breast cancer, but that is changing (while their genetics haven’t). From 1993 to 1997, the rate increased by 6.3 percent, surpassing the incidence in black women.The authors suggested that diet and exercise and other environmental factors are the most likely contributors to this shift.

Heart patients on a cholesterol-lowering diet were put on an exercise program, with 30 to 60 minutes of walking, jogging, or cycling 3 to 6 times a week. After six months, they further reduced their LDL cholesterol, while not changing the level of good HDL cholesterol. Oxidized LDL is the most damaging to the arteries. Their blood pressure also declined. (Welty FK, et al., Am J Cardiol 2002 May 15;89(10):1201-4.)

Diet and Disease
Ground beef that was sold nationwide has been recalled by ConAgra, the nation’s second largest supplier of food and meat. The 19 million pounds of ground beef was contaminated with potentially deadly E. Coli bacteria. The E. coli come from fecal contamination of carcasses during processing, which is extremely common. The bacteria can cause bloody diarrhea, dehydration, and kidney damage. The USDA, charged with protecting consumers, waited 10 days after learning of the contamination before notifying the company. I wonder just whom they are protecting. The risk of bacterial contamination is just one of many reasons to eliminate meat from the diet. (Reuters, July 19, 2002)

Recipe of the Month: A Light Summer Fruit Salad
A healthy fruit salad is a great way to start the day in summer, when organic fresh fruits are abundant, but this can also be a meal at any time. Cut up bananas, peaches, pineapple, oranges, and grapefruits, and add some fresh berries (rich in antioxidants) and grapes. I like to add chunks of fresh Medjool dates. Chopped toasted almonds provide protein, fatty acids, and a toasty flavor. In a small electric coffee mill, grind up 2 to 3 Tbsp of flaxseeds, and sprinkle these in the salad. They contain cancer-protective lignans, fatty acids, and some protein. As a sauce, I mix some orange juice with organic non-fat yogurt, or soymilk. Instead, you can blend silken tofu (very creamy) with the juice for a thicker sauce. Any ingredient is optional, depending on your taste.

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Herb Safety
McRae CA, et al., Hepatitis associated with Chinese herbs. Eur J Gastroenterol Hepatol 2002 May;14(5):559-62.

Hormone Replacement Therapy
Writing Group, Risks and benefits of estrogen plus progestin in healthy postmenopausal women.. JAMA 2002 Jul 17;288(3):321-33.
Clarkson TB, Progestogens and cardiovascular disease. A critical review. J Reprod Med 1999 Feb;44(2 Suppl):180-4.
Khurana PS, et al., Hormone replacement therapy for...coronary heart disease... Curr Atheroscler Rep 2001 Sep;3(5):399-403.
Persson I, et al., Hormone replacement therapy and the risk of breast cancer.... Int J Cancer 1997 Sep 4;72(5):758-61.
Ross RK, et al., Effect of hormone replacement therapy on breast cancer risk: estrogen versus estrogen plus progestin. J Natl Cancer Inst 2000 Feb 16;92(4):328-32.
Wagner JD, Rationale for hormone replacement therapy in athero-sclerosis prevention. J Reprod Med 2000 Mar;45(3 Suppl):245-58.
Waring SC, Postmenopausal estrogen replacement therapy and risk of AD... Neurology 1999 Mar 23;52(5):965-70.
Warren MP, et al., Use of alternative therapies in menopause. Best Pract Res Clin Obstet Gynaecol 2002 Jun;16(3):411-48.
Nagata C, et al., Hot flushes and other menopausal symptoms in relation to soy product intake in Japanese women. Climacteric 1999 Mar;2(1):6-12.
Wilson RS, et al., Participation in cognitively stimulating activities and ...Alzheimer disease. JAMA 2002 Feb 13;287(6):742-8.

Blood Pressure and Cholesterol
Langsjoen PH, et al., A six-year clinical study of therapy... with coenzyme Q10. Int J Tissue React 12:169-171; 1990.
Arsenio I, et al. ...long-term treatment with pantethine in patients with dyslipidemia. Clin Ther 1986;8:537-545.
Silverberg DS. Non-pharmacological treatment of hypertension. J Hypertens Suppl 1990 Sep;8(4):S21-6.
Key TJ, et al., Health benefits of a vegetarian diet. Proc Nutr Soc 1999 May;58(2):271-5.


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From September to June, I see patients in New Smyrna Beach, Florida.
Call 386-409-7747, or send an email to to make arrangements.

In summer, I have a variable schedule, and I see patients in offices at the
Rothfeld Center for Integrative Medicine in Waltham, Massachusetts. For appointments, send an email to make arrangements, or call: 386-409-7747.

I primarily do phone consultations, as well as email and instant messaging consults.

Information herein is not medical advice or direction. All material in this newsletter is provided for information only. Its contents should not be used to provide medical advice on individual problems. Consult a health care professional for medical or health advice.